Diabetes Issue

[JaClasse]

I need a quick response on this one! We are a small private camp. Our sessions generally have about 90-130 campers and most are healthy. There is one nurse on duty 24/7. We have a 8 year old camper that is wanting to come to camp. She is diabetic and wears an insulin pump. Our problem is that her doctor has ordered her BG to be checked at midnight and 3 AM (along with at meals and 2 hours after meals). I can not ask a counselor to take this responsibility. If she would have to get up every night for this, she would never be able to function for the rest of the girls in her cabin. The same goes for the nurse.

I have contacted the doctor. She is insistent that the BG's be done at the night times. (The day times would not be a problem for us). The mother does not think it's necessary. We have tried to think of different options including:

1) Having a staff member stay with her one-on-one (We do not always have a staff member available, so are hesitant to set this precedence)

2) Have a friend/family member stay with her. Her mother does not have anyone and this would also cost the camp extra money.

3) Have the camper go home for night. They live close enough to do this, however the mother doesn't want her to be singled out, like this.

4) Kindly tell the parents that we are just not set up to meet the needs of this camper.

I'd like your input. How have you handled (or how would you handle) this situation?

[Neveranurseagain, RN]

We have a form at our camp that allows a parent to "override" an order from an MD that the parent signs. It states that the parent is aware of what the MD requests, but the parent does not agree to the plan of action or restriction placed on the camper and agrees to assume responsibility for changing it. It is used at our camp as there are a few MD's that tell every camper that is seen in the ER to go home, even for simple injuries/illnesses. Parents have the right to decline treatment options for minors, if it is not life threatening.

Another option is to have the parents get involved and have them ask the MD about it and his rational. If it is not checked at these times at home, why at camp? They need to interact with their MD and find another one if they don't agree with his care plan. You could also ask the parent to get clearance from another doctor not to do these finger checks. Counselors can be trained to do finger checks, with written parameters listed as to the action required too. Non medical school personnel do this every day on hundreds of children while at school.

[Neveranurseagain, RN]

As a side note, we usually have a diabetic every week that comes to camp with a pump, as well as other diabetics that are not on pumps. What I'd be concerned with is whether or not she can change the site herself and manage the pump herself, with her mom on the phone coaching, if needed. There are a few different pumps out there, and it is not up to the camp nurse to be fully trained on each one. But I have never had an MD order night time BS. You might also call one of the camps that specialize in DM and see their policies for checking BS.

[mamamerlee, LPN]

I've worked at 2 different camps where there were diabetics, and no one ever had a 3 AM fingerstick. I have been diabetic 9 years, and rarely do an overnight check. Maybe this doctor is being overly cautious.

[smiley321]

I have also found this to be a problem. I had a camper last year who had to do 2am checks, which the parent did not mention during our discussions before camp. It took its toll on myself and her counsellor, as I am the only medical staff and she is the only counsellor. Personally, I am considering telling her we are not set up to do nightly checks. She may do them herself if parent and doctor are okay, and of course come to the Wellness Centre if there is an issue, but it's too much to request staff to wake/stay up in a camp that is primarily for healthy kids.

[kampnurse817]

I know that this is an old post, but if you get this message, I was wondering if you have a copy of that form that the parent can sign. We don't have that at the camp I work at and in alot of instances, it would be a big help. Thanks for you help if you get this.